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Procurement, Allocation, and
Transplantation
By Deborah Nierste
ABSTRACT: Organ transplantation extends lives and improves
health but presents complex ethical
dilemmas for nurses caring for
donors, recipients, and their families.
This article overviews organ procurement and allocation, discusses ethical
dilemmas in transplantation, and
offers strategies from professional and
biblical perspectives for coping with
moral distress and maintaining
compassionate care.
KEY WORDS: moral distress,
nursing, organ transplantation,
­workplace coping
80 JCN/Volume 30, Number 2journalofchristiannursing.com
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
E
xpanding knowledge and
technology in organ and
tissue transplantation are
providing hope for the
treatment of chronic
diseases and new life for those who
otherwise would experience incapacity
or premature death. Although organ
transplantation extends lives and
improves health, it presents complex
ethical dilemmas and questions that do
not have easy answers. Who should be
eligible to receive transplants? Should
illegal aliens, foreigners, people with a
history of addiction or noncompliance,
or convicted criminals be eligible?
Who should have first priority to
receive transplants: patients in the
greatest need or those most
likely to benefit with the best
long-term outcome? How is
end-of-life determined
for deceased donors?
Nurses working in
various settings can find
their personal values in conflict with
the law, the values and decisions of
colleagues, and/or the values of the
patients and families who donate or
receive transplants. For example, the
United States Constitution guarantees
healthcare for prisoners (Fung, 2011). A
nurse may feel it unfair for a criminal
to receive an organ ahead of a lawabiding citizen. Yet nursing actions are
directed by the patient’s right to autonomy, the law, or decisions made by
colleagues—whether or not they agree
with the process and outcomes. These
conflicts can initiate inner turmoil that,
if left unchecked, can lead to moral
distress. What help is there for nurses to
Deborah Nierste, BSN, RN, serves as
an Adjunct Faculty at Indiana Wesleyan
University, Marion, Indiana, and is
pursuing a Master of Science in Nursing
Education.
Accepted by peer review 12/13/12.
The author declares no conflict of interest.
DOI:10.1097/CNJ.0b013e3182839b47
journalofchristiannursing.com
deal with moral turmoil and continue
providing excellent patient care?
Brief History of
­Transplantation
Ancient literature suggests human
organ transplantation may have been a
treatment for diseased tissue as early as
450 BC as the Sushruta manuscripts
contain a description of the first skin
transplant (Klein, Lewis, & Madsen,
2011). Schlich (2011) credits the “first
organ transplant in the modern sense”
(p. 1372) to Swiss surgeon Theodor
advancements opened the door
for present-day successful organ
transplantation.
Today, transplantation of the heart,
lung, heart/lung together, liver, kidney,
pancreas, pancreatic islets, kidney/
pancreas, intestines, hematopoietic stem
cells, bone, cornea, skin, and face
(composite tissue allotransplantation) is
performed (Klein et al., 2011). Organs
and tissues from one donor can
potentially save up to eight lives,
whereas tissues from the same donor
can benefit 50 lives (Donate Life,
Organs and tissues from one
donor can potentially save up
to eight lives, while tissues
from the same donor can
­benefit 50 lives.
Kocher. In 1883, Kocher transplanted
healthy thyroid tissue into patients
who had undergone a thyroidectomy
to observe whether or not this would
reverse symptoms now known as
hypothyroidism. His technique
established a model for future organ
transplantations.
Despite obstacles and setbacks, the
process of transplantation progressed.
German scientist Karl Landsteiner
contributed with his discovery of the
blood group system and its relationship
to organ rejection. Alexis Carrel and
Mathieu Jaboulay furthered the
development of organ transplantation
with successful vascular suturing
techniques. Joseph Edward Murray’s
use of immunosuppressive drugs
allowed the first successful kidney
transplant from an unrelated donor in
1962 (Klein et al., 2011). These
2010). Recipient complications of
transplantation include rejection,
infection, and cancer from long-term
immunosuppressive therapy (Klein et
al., 2011). However, the success of
transplantation is demonstrated by
5-year survival rates for organ recipients (Table 1), supporting the value of
transplantation programs.
How Are Organs
­Procured?
Although some organs (kidney,
partial liver, partial lung) are procured
from live donors, most organs come
from deceased donors. Approximately
three of every four organs transplanted
are recovered from deceased donors
(Steinbrook, 2007). Typically organ
donation only is possible when a
person dies as a result of irreversible
cessation of all brain function, known
JCN/April-June 2013 81
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
as Donation after Brain Death or DBD,
while their heart and lung function is
artificially maintained (National Health
and Medical Research Council, 2007).
Few people die in ways that allow
them to become donors. Persons who
are HIV, hepatitis B or D seropositive;
have current neoplastic conditions
(with some exceptions); systemic
infection from agents for which
treatment is not feasible (i.e., methicillinresistant Staphylococcus aureus); a prion
disease (i.e., Creutzfeldt–Jakobs); or for
whom risk assessment is not possible
cannot donate organs.
The Uniform Determination of
Death Act (UDDA) states “an individual, who has sustained either irreversible
cessation of circulatory and respiratory
function, or irreversible cessation of all
functions of the entire brain, including
the brain stem, is dead” (U.S. President’s
Commission for the Study of Ethical
Problems in Medicine and Biomedical
and Behavioral Research, 1981, p. 2).
Current practice allows organs to be
removed from patients who are
­considered brain dead and from those
who expire as a result of cardiac death.
In every case certain criteria must be
met before organs can be procured.
The key term in determining cardiac
death is irreversible, meaning the heart
has permanently stopped beating and
cannot be restarted through intervention. Obtaining organs from donors
after cardiac death was the approach
used prior to 1970 (Steinbrook, 2007).
With the formulation of the UDDA in
1981, cardiac death criteria continued
to be used, but more attention was
given to brain death. Brain death
typically denotes that the brain ceases
to function before the heart stops
beating; breathing and heartbeat are
assisted mechanically but will likely
cease once mechanical intervention is
removed. To determine brain death, a
series of tests are performed to determine if there is absence of brainstem
reflexes, motor responses, and absence
of respiration when removed from
artificial ventilation. Other tests can
verify absence of brain activity and
intracranial blood flow. If a person is
TABLE 1: Five-Year Survival Rates for Select U.S.
Organ Transplants Performed 1997–2004a
Organ:
Females
Number
Alive
% Survival
Rate
Number
Alive
% Survival
Rate
Heart
4,522
73.2
1497
69
Lung
802
46.6
815
47.3
Heart/lung
29
35.8
45
41.4
19,430
84.2
13,667
85.8
Pancreas
339
84.6
280
79
Kidney/pancreas
1537
86
1036
84.4
Liver
6496
71.8
4460
73
62
49
49
45.5
Kidney
Intestine
a
Males
Latest available data as of January 25, 2013.
Source: Organ Procurement and Transplantation Network. (2013). Data: Data reports: National. Retrieved from
http://www.unos.org/donation/index.php?topic=data
declared brain dead then he or she is
clinically and legally dead and may be
considered a candidate for organ
donation. The brain-based definition of
death became acceptable as criteria for
transplantation since the brain-dead
patient is no longer considered living
(based on neurological criteria), but
maintains viable organs that have been
continually perfused by a fully functioning heart (Steinbrook, 2007).
Today, a rising demand for organs
and decreasing number of brain-death
donors has stimulated a renewed
interest in cardiac-death donors
(Zamperetti, Bellomo, & Ronco, 2009).
Donation after Cardiac Death (DCD),
formerly known as non-heart-beating
organ donation (NHBOD), is now
recognized when defining death. In
DCD, solid organs are procured after
the heart stops beating (usually within
5 minutes of cardiac arrest) following
withdrawal of life-sustaining treatment
(WLST) (Rady, Verheijde, & McGregor,
2007). Organ retrieval in this case
occurs only after “irreversible cessation
of respiration and circulation has been
declared” (Rabinstein et al., 2012, p. 414).
If solid organ retrieval (heart, kidneys,
etc.) cannot occur quickly, other
tissues not as dependent on blood
perfusion can still be harvested (i.e.,
skin, cornea, bone).
Many controversies surround both
DBD and DCD. Marquis (2010, p. 25)
asserts that “...the permanence of the
cessation of circulatory function in
DCD donors does not entail its
irreversibility.” He contends that when
a person presents in the emergency
department (ED) with no heartbeat,
but is successfully resuscitated, they
were in the same physiological state as
a patient declared dead by the DCD
protocol, hence a potential conflict.
Furthermore, declaring either brain or
cardiac death, is fraught with emotional
complexity and turmoil for providers
and patients’ families and friends.
Once a patient has met criteria for
becoming a potential donor, a healthcare professional contacts the local
organ procurement organization
affiliated with the hospital. A professional trained in the donation process
makes an onsite visit to assess and
evaluate the potential donor’s medical
82 JCN/Volume 30, Number 2journalofchristiannursing.com
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condition and history. Once a physician performs the required tests and
declares the patient to be brain dead, a
transplant coordinator from the organ
procurement organization also makes
an onsite visit to review the patient’s
information and meet with the medical
team and family. When consent from
the family is obtained, a search for
potential recipients begins.
It should be noted that “Nearly all
religious groups support organ and
tissue donation and transplantation as
long as it does not impede the life or
hasten the death of the donor” (United
Network for Organ Sharing [UNOS],
2012, para 2). Summary statements from
a large number of faith traditions about
organ donation and transplantation can
be found on the UNOS website under
“Fact Sheets: Theological Perspectives.”
As soon as recipients are located, the
donor is taken to the operating room
where the organs are removed from the
body. The retrieved organs are flushed
with a cool solution to remove all
blood. The organ is measured, evaluated,
and packaged in a sterile environment
the most ­regulated areas of healthcare
today” (n.d., para. 1). State laws
generally address the process of
donation. The National Conference of
Commissioners on Uniform State
Laws formulated the Uniform Anatomical Gift Act (UAGA) of 1968. The
UAGA regulates state laws on the
donation of organs and tissues from
cadavers (Clemmons, 2009). This law
also lists the hierarchy for next of kin
notification.
Federal laws focus on the procurement, allocation, and transplantation
of donated organs. The National
Organ Transplant Act, enacted in 1984,
established the Organ Procurement
and Transplantation Network (OPTN).
This federal organization maintains a
“list of patients waiting for transplants,”
operates “a system for matching
donated organs with individuals on
the list,” establishes “medical criteria
for allocating organs,” collects and
analyzes “data on organs donated and
transplanted,” and conducts “work to
increase the supply of donated organs”
(OPTN, 2012b, para. 2). The OPTN is
citizens who are not U.S. residents
(OPTN, 2012c). Once the person’s
pertinent information is entered into
the OPTN database, the computer
generates a prioritized list of persons
suitable to receive organs, matching
these candidates to donors (Transplant Living, 2012). The rules for
allocation vary by organ but these
general principles guide the allocation process: (1) patient’s medical
urgency, (2) blood, tissue, and size match
with the donor, (3) time on the waiting
list, and (4) proximity to the donor
(Brezina, 2010).
Who Should Receive
­Organs?
According to UNOS, in February
2013 117,086 people were waiting for
organ transplants in the United States;
23,360 transplants occurred January to
October 2012 from 11,663 donors
(OPTN, 2012a). In 2010, a total of
6,521 patients died while waiting for
organ transplants (Donate Life, 2010).
Clearly the need for organs is far
greater than the quantity available and
Nearly all religious groups support organ
and tissue donation and transplantation as
long as it does not impede the life or hasten
the death of the donor.
managed by the UNOS that develops
and monitors policies for OPTN,
facilitates procurement and allocation
of organs, and collects and analyzes data
The Current
regarding transplantations (Crowe &
Cohen, 2006).
­Allocation System
A system governed by state laws,
Currently in the United States, to
federal laws, federal regulations, and
be added to the UNOS waiting list a
UNOS policies attempts to guarantee
person must be in end-stage organ
fairness in the distribution of donated
failure and seen by a physician at a
organs. The U.S. Department of Health U.S. hospital where transplants are
& Human Services (DHHS) asserts
­performed (Clemmons, 2009). This
that “the field of organ and tissue
includes U.S. citizens, non-U.S. citizens
donation and transplantation is one of
who are U.S. residents, and non-U.S.
with ice for transportation. Tissue and
blood samples are taken from the donor
for further testing (Gift of Life, n.d.).
journalofchristiannursing.com
complex decisions must be made as to
who receives available organs. Consider
the following true scenarios:
Potential Recipients: A 16-year-old
female collapses at a family dinner and is
transported to the ED and admitted with
a massive myocardial infarction due to
thrombosis of a major coronary artery.
Her condition deteriorates to the point
that a ventricular assist device (VAD) is
inserted until heart transplantation can
occur. The family is paying for her care
with the assistance of medical insurance
(Hollar, 2012; Trachtenberg, 2010).
JCN/April-June 2013 83
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A 27-year-old male is admitted
with a previous history of congestive
heart failure treated with a pacemaker
defibrillator and medication. The
patient’s condition has worsened and
greater intervention is needed. A
VAD is implanted while the patient
awaits a heart transplant. Armed
guards accompany him since he is a
prisoner serving an 11-year sentence
for drug convictions. The cost of his
care is covered by the government
(Associated Press, 2009; Green,
2011).
Second Time Around: A 16-yearold male with juvenile diabetes is
admitted to a dialysis center in need
of peritoneal dialysis due to kidney
failure. He has been noncompliant
with his diabetic regimen. He is placed
on the transplant list and eventually
receives a kidney. Posttransplantation
he does better with his diabetic care,
but eventually stops taking his antirejection medications. He also begins
smoking cigarettes and using marijuana.
Several years later, the transplanted
kidney begins to fail, creating the need
for another donor kidney (E. Martin,
personal communication, February 15,
2012).
A Tragic Donor: A 23-year-old is
rushed to the ED after sustaining
massive head trauma in an automobile
accident. She is resuscitated, intubated,
and placed on a ventilator. She is given
intravenous medications and blood
transfusions, but remains unresponsive.
Over the next few days physicians
perform a series of rigorous tests to
determine brain activity and blood
flow through the brain. Testing reveals
absence of brainstem reflexes and
motor responses in addition to
absence of respiration when removed
from the ventilator; other tests verify
absence of brain activity and intracranial blood flow. The patient is declared
brain dead by two physicians, each
having conducted his own independent testing. The family has agreed to
donate this patient’s organs (BestofBay.
com, 2012).
All of these scenarios, as well as
many others, occur in the real world.
TABLE 2: General Recipient Contraindications to
Transplanta
•
•
•
•
•
•
•
•
•
•
•
•
•
Incurable or serious active infection
Active malignancy
Any condition with a death prognosis < 5 years
Untreatable severe psychiatric or psychological condition
Severe neurological deficits
Severely limited functional status (i.e., severe mental retardation)
Substance abuse within last 6 months
Complete absence of reliable/consistent social support system
Convincing evidence of non-compliance
Obesity (body mass index [BMI] range > 30–45 kg/m2)
Severe cachexia (BMI < 17–18 kg/m2)
Inadequate financial resources
Multiple intercurrent conditions
a
Collected from a variety of transplant programs in the United States and England; specific organ transplants may
have additional contraindications.
These situations are challenging and
controversial, bringing dilemmas nurses
face as they provide care. The dilemmas, both discernible and obscure,
include allocation and distribution of
organs, shortage of organs, and procurement of organs from dying donors.
ETHICAL DILEMMAS IN
­TRANSPLANTATION
Transplantation is an expensive
procedure involving the cost of the
surgical process along with rehabilitation and lifetime immunosuppressive
maintenance. Because of the expense,
the scarcity of organs, and the risk of
rejection or failure of newly transplanted
organs, it is necessary to consider only
medically suitable recipients. Recipient
contraindications from a number of
transplant programs are given in Table 2.
However, even these contraindications
can be imprecise. Questions arise such
as: Where do you draw the line when
determining which patients are
medically suitable? What is fair selection? Does this include choosing those
in need as a result of addictive, abusive,
or poor health behaviors over those
without history of addictions? Most
transplant organizations require patients
Web Resources
United Network for Organ Sharing—
http://www.unos.org
Organ Procurement and
Transplantation Network—
http://optn.transplant.hrsa.gov
International Transplant Nurses
­Society—http://www.itns.org
Donate Life America—
http://donatelife.net
Gift of Life—
http://www.donors1.org
to be smoke-free and substance
abuse-free for at least 6 months to be
on the waiting list, and it is expected
they remain smoke and drug-free. Little
research is available that addresses the
relapse rate in transplantation cases;
however, one study reported one in
four heart transplant recipients resume
smoking (Macrae, & Hagan, 2008). The
relapse rate for alcohol use after transplantation falls within a range of 2 to 10
for every 100 people (McGowan
Institute of Regenerative Medicine,
2012). In addition, one cannot individually predict which patients will
relapse; this issue raises moral distress
and questions of fairness.
84 JCN/Volume 30, Number 2journalofchristiannursing.com
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Likewise, is it fair to include those
who are incarcerated for heinous
crimes, often with a history of addictive behaviors? The law protects
prisoner rights to healthcare by virtue
of the Eighth Amendment to the
Constitution (Fung, 2011). Law-­
abiding citizens must pay for their own
transplants while prisoner transplants
are provided for by taxpayers (Hill &
Mooney, 2012; Leung, 2009; Loew,
2012). Is it fair for a criminal to receive
an organ before a law-abiding citizen?
UNOS states that convicted criminals
are “sentenced by the judicial system
only to a specific punishment, i.e.,
incarceration, fines, or probation, not to
additional punishment such as inability
to be considered for medical services”
(OPTN, 2012c).
Similarly, where should the line be
drawn when a patient is medically
suitable but cannot afford transplantation? Patient financial status and
insurance coverage can be considerations when placing a person on the
waiting list. Research shows the poor
and the uninsured are less likely to
receive a transplant since their inability
to pay for the immunosuppressive
medication will result in failure of the
donated organ (Laurentine &
­Bramstedt, 2010).
Salahi (2011) reports that
“transplant centers have the
right to turn patients away,
but physicians are required
to care for every patient
they see” (Sydney D.
Caplan as cited in
Salahi, para. 9). In the
first scenario above,
if the two young
patients are determined to have equal medical
urgency with the same blood, tissue
and size match, and proximity to the
donor, but the 27-year-old male
patient was placed on the list first, then
he could be awarded the organ despite
his involvement in illegal drugs and
incarceration. Likewise, should the
noncompliant diabetic patient in
the second scenario test drug-free for
6 months, he could receive a kidney
journalofchristiannursing.com
transplant ahead of another patient
who also is in need of a transplant and
has been compliant with the medical
regimen. Is it ethical to give organs to
patients who have caused or precipitated their organ failures when others
may die as a result?
Given the three scenarios and assuming that all criteria are met, it is possible
that the 23-year-old victim rendered
brain dead could become the donor of
the heart for the criminal whose heart
may have been damaged as a result of
drug use. At the same time the 18-yearold teenager with a VAD dies while
waiting for a heart, through no fault of
her own. This same donor could
become the donor of a kidney for the
patient who is need of a second kidney
transplant due to noncompliance and
illegal drug use. These outcomes can
create emotional conflict and lead to
moral distress for nurses caring for these
patients. Furthermore, in most cases
despite whether or not they agree, final
decisions are out of the nurses’ hands.
Nurses experience moral distress
when personal values conflict with
ethical obligations on a regular basis
while caring for patients and their
families. It is not uncommon for moral
distress to result when dealing with
sion, frustration, feelings of reduced
self-worth, and withdrawal from family
and friends (Gallagher, 2010; Schluter,
Winch, Holzhauser, & Henderson,
2008; Wiegand, & Funk, 2012). Moral
distress affects the health of nurses and
their provision of care, job satisfaction,
retention, and personal relationships.
The distress can become so great that
nurses do not want to care for their
patients or their families and begin to
work fewer hours, eventually leaving
the nursing unit or the profession
altogether (Gallagher, 2010; Schluter
et al., 2008; Wiegand, & Funk, 2012).
How can nurses respond to moral
conflicts to manage distress?
COPING WITH
­MORAL ­CONFLICT
Many years ago a wise nursing
instructor told me it’s necessary to first
take care of the nurse, so the nurse can
take care of the patient. Individual
management of daily stressors is key to
nurses’ well-being and job performance
when dealing with difficult dilemmas.
Thankfully, God provides biblical
principles to deal with stress and moral
conflict.
When Jesus was under stress he
applied Scripture. Knowing God’s Word
The field of organ and tissue
donation and transplantation is
one of the most regulated areas
of healthcare today.
end-of-life situations, including those
that involve fair allocation of resources and protecting patients’ rights
­(Lazzarin, Biondi, & Di Mauro, 2012;
Radzvin, 2011; Repenshek, 2009).
Nurses who experience moral distress
have reported physical symptoms such
as headaches, neck pain, and stomach
problems. Psychological and emotional
symptoms include anger, guilt, depres-
helped him bout Satan (Matthew 4:1-11),
when criticized (Matthew 9:10-13;
Mark 2:23-28), and at his Crucifixion
(Luke 23:35-43, 46). Studying God’s
Word provides a way to know God
intimately and reveals his wisdom and
direction for difficult situations.
Throughout his life, Jesus got alone
and prayed to seek God’s presence
(Matthew 14:23; Luke 22:39-46). In
JCN/April-June 2013 85
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addition to quiet times with God
outside of work, nurses can use break
time for a brief walk outside or rest
in a quiet room for a few minutes.
Distance from difficult circumstances
enables us to not only release emotions,
but reflect on the situation and analyze
thoughts, feelings, and emotions (Lim,
Bogossian, & Ahern, 2010). A time of
prayer and reflection strengthens the
spirit and helps us focus on God and
gain his perspective (Philippians 4:8).
This clearing of the mind and strengthening of the spirit provides the clarity
necessary to continue care and work
through dilemmas. This is an important
concept for a nurse caring for a
It is important to develop personal
relationships to build a support system
for challenging times. Lack of social
support has a “direct effect on emotional exhaustion and burnout” (Prins
et al. as cited in Pardoe, 2011, p. 28).
In Scripture, Martha’s sister Mary
demonstrated building relationships.
Mary chose to abandon her duties
temporarily and do nothing but sit at
Jesus’ feet (Luke 10:38-42). Nurses can
set priorities to spend time with God
and others to help them through
stressful events. “Knowing that support
is readily available can greatly enhance
coping strategies and help ease the
tension or perception of stressors”
Because of his faith and trust, ­Abraham’s
life was changed forever (Genesis
12-22). Being faced with dilemmas
enables nurses to reach out to and
reflect on God’s faithfulness, knowing
God will take care of them and their
patients, somehow meeting their needs
during difficult times (Proverbs 3:5-6),
and working with them to bring about
good (Romans 8:28).
PROFESSIONAL CARING
Despite difficult circumstances,
nurses have the responsibility to act as
an advocate for the patient and to
practice compassionately within legal,
ethical, and professional standards. The
Professional and spiritual sources
help nurses compassionately
care in difficult transplant situations.
potential donor. Removing oneself
from the situation permits the nurse
to mentally transition the focus from
caring for the living to maintaining
organs that will give others a second
chance at life.
Renewing the mind alleviates
troublesome thoughts, which, in turn,
enables the body to sleep better. Rest,
along with proper nutrition and exercise,
can restore the body and give strength.
While feeding the 5,000 the disciples
were so busy they did not have time to
eat. At one point Jesus pulled them
aside and accompanied them to a place
where they could rest (Mark 6:31).
Rest need not always involve sleep but
can entail leisure activities such as
relaxation practices (walks, massages),
vacations, hobbies, and entertainment.
Healthy eating and exercise help with
endurance and strength. It is important
to keep the body healthy and rested so
nurses are better prepared for wearing
responsibilities.
(Gurung, 2006 as cited in Pardoe,
2011, p. 29). Seeking help from
in-house ­support groups for those
working with transplant patients or
palliative care can be beneficial.
Research has shown that these groups
help staff members identify the effect
of traumatic experiences and losses,
while validating their experiences
(Hanna, & Romana, 2007).
The Bible encourages God’s
followers to persevere to grow spiritually.
Perseverance through difficulty makes a
person stronger (2 Corinthians 4:16-18;
James 1:2-4; 1 Peter 1:6-7). Jesus was a
great example of perseverance throughout his life and especially through his
Crucifixion (Hebrews 12:1-3).
The final principle encompasses
putting trust in God and his faithfulness
during difficult times. Because of the
relationship Abraham had previously
built with God, Abraham was able to
trust God when he had no heir and
later, to sacrifice his only son Isaac.
American Nurses Association (ANA)
Code of Ethics for Nurses with Interpretive
Statements (2001) states, “the nurse
respects the worth, dignity, and rights
of all human beings irrespective of the
nature of the health problem. The
worth of a person is not affected by
disease, disability, functional status, or
proximity to death” (p. 3). Shelly and
Miller explain that Christian caring is
“hands-on, patient-centered, physical,
psychosocial and spiritual intervention
to meet the needs of a patient regardless
of how the nurse feels” (2006, p. 250).
Puchalski adds that “Compassion is an
attitude, a way of approaching the
needs of helping others with their
suffering, but it is also a way of being, a
way of service to others, a spiritual practice, and an act of love” (2009, p. 188).
Christ calls us to care for everyone,
even the least deserving, as we would
care for him (Matthew 25:31-46),
reminding us that God values all life
and in every detail, stage, and condition
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(Luke 12:6-7). These professional and
spiritual sources help nurses compassionately care in difficult transplant
situations.
Nurses working in areas that relate
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can be empowered to fulfill the
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them. A key to persevering through
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on the purpose; providing care that is
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provides motivation, keeps priorities
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